2025 VBP Behavioral Health/HARP Quality Measure Set

Value Based Payment Quality Measure Set
Measurement Year 2025

  • Measure Set is also available in Portable Document Format (PDF)

January 2025                     NYS Medicaid Value Based Payment

INTRODUCTION

The Measurement Year (MY) 2025 Health and Recovery Plan (HARP) Quality Measure Set was created in collaboration with the Behavioral Health/HARP Clinical Advisory Group (CAG), the Primary Care (Physical Health) CAG, the New York State Department of Health (the Department) CAG Strategy team, as well as subject matter experts from both the NYS Office of Mental Health (OMH) and NYS Office of Addiction Services and Supports (OASAS). The goal of this measure set is to align with measures put forth in the NYS Quality Assurance Reporting Requirements (QARR), the Healthcare Effectiveness Data and Information Set® (HEDIS)1 Technical Specifications for Health Plans, the Centers for Medicare & Medicaid (CMS) Core measure set, and the Merit-based Incentive Payment System (MIPS), where applicable. The measure set is designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings.

MEASURE SELECTION AND FEASIBILITY

Upon receiving recommendations from the CAGs, other NYS agencies, the release of guidelines from national measure stewards such as National Committee for Quality Assurance (NCQA)/HEDIS® and in accordance with the NYS Value Based Payment (VBP) Roadmap,2 the Department defined a final list of measures to be included in the Behavioral Health/HARP Measure Set for MY2025. For MY2025, there are a total of thirty Category 1 and 2 HARP Quality Measures.

VBP ARRANGEMENT REQUIREMENTS FOR MY2025 - HEALTH EQUITY

In MY2022, NCQA added race and ethnicity stratification to several HEDIS measures to help promote transparency in health plan performance. Because high-quality care requires equitable care, NCQA hopes to better identify where disparities exist so they can be addressed. They also hope to identify and learn from top performers in areas where disparities don't exist. To align with this initiative, in July 2022, NYS required payers and providers to incorporate race and ethnicity measure stratification in VBP arrangements. For MY2025, there are 26 HEDIS stratified measures. Twenty-two of these are included in various New York Medicaid VBP arrangement type measure sets for payers and providers to add to their VBP contracts. Please refer to the following section for VBP contracting stratification specifications for MY2025.

Stratification Specifications:

  1. Payers are required to include at least one of the following measures in all level 1 or higher VBP contracts and stratify results by race and ethnicity categories as outlined in the HEDIS MY2025 specifications.3
NCQA Measure Name Measure Inclusion by Arrangement Type
TCGP HARP/BH Maternity HIV/AIDs Children's
Adult Immunization Status (AIS-E)* ✓        
Asthma Medication Ratio (AMR)* ✓ ✓   ✓ ✓
Breast Cancer Screening (BCS-E)* ✓ ✓   ✓  
Cervical Cancer Screening (CCS-E) ✓ ✓   ✓  
Child and Adolescent Well-Care Visits (WCV) ✓       ✓
Childhood Immunization Status (CIS-E) ✓       ✓
Colorectal Cancer Screening (COL; COL-E) ✓ ✓   ✓  
Controlling High Blood Pressure (CBP) ✓ ✓   ✓  
Eye Exam for Patients with Diabetes (EED) ✓ ✓   ✓  
Follow-Up After Emergency Department Visit for Mental Illness (FUM) ✓ ✓     ✓
Follow-Up After Emergency Department Visit for Substance Use (FUA) ✓ ✓      
Follow-Up After Hospitalization for Mental Illness (FUH) ✓ ✓      
Glycemic Status Assessment for Patients with Diabetes (GSD) ✓ ✓   ✓  
Immunizations for Adolescents - Combo 2 (IMA, IMA-E) ✓       ✓
Initiation and Engagement of Substance Use Disorder Treatment (IET) ✓   ✓ ✓  
Kidney Health Evaluation for Patients with Diabetes (KED) ✓ ✓   ✓  
Pharmacotherapy for Opioid Use Disorder (POD) ✓ ✓      
Postpartum Depression Screening and Follow-Up (PDS-E)     ✓    
Prenatal and Postpartum Care (PPC) ✓   ✓    
Prenatal Depression Screening and Follow-Up (PND-E)     ✓    
Prenatal Immunization Status (PRS-E)* ✓   ✓    
Well-Child Visits in the First 30 Months of Life (W30) ✓       ✓

Stratification Requirements:

  1. Any measure(s) from the preceding table can be selected for stratification of race and ethnicity provided the two groups approve on the contracting elements around other performance of the measure.
  2. Payers are required to include the following details in the Provider Contract Statement and Certification form (DOH-4255)4 and Contract language:
    1. Indicate what measure(s) are included for race and ethnicity stratification.
    2. Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
  3. Plans are required to include the race and ethnicity data when submitting to NYS using the following method:
    1. Race and ethnicity fields will be added to the annual VBP member attribution submission file specifications. This will allow the Department to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.

All new contracts must meet this requirement to be approved by the Department. As of April 1, 2023, all other existing contracts were to be updated/amended at the end of the contract's current measurement period and before the contract's next measurement period began.

MEASURE CLASSIFICATION

Each measure has been designated by the Department as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).

Category 1

Category 1 quality measures, as identified by the CAGs and accepted and deemed reportable by the Department, are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.5 At least one Category 1 P4P measure must be included in a VBP contract.

The Department classified each Category 1 measure as either P4P or P4R:

  • P4P measures are intended to be used to determine shared savings amounts for which VBP Contractors are eligible.
  • P4R measures are intended to be used by the Managed Care Organizations (MCOs) to incentivize VBP Contractors to report data to monitor the quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and Department review or as determined by the MCO and VBP Contractor.

Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next few years. Please refer to the 2025 Value Based Payment Reporting Requirements Technical Specifications Manual (MY2025) for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.

Categories 2 and 3

Category 2 measures have been accepted by the Department based on the agreement of clinical importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility.

Measures designated as Category 3 were identified as unfeasible at this time, or as presenting additional concerns, including accuracy or reliability, when applied to the attributed member population for an arrangement; therefore Category 3 measures are not included in the measure set.

MY2025 HARP QUALITY MEASURE SET

The measures and Department-determined classifications provided on the following pages are recommendations for MY2025. Note that measure classification is a Department recommendation, and implementation is to be determined between the MCO and VBP Contractor.

Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include measure additions, deletions, recategorizations, and/or reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. Please see Appendix A for a full list of these changes.

Category 1

The table below displays the Category 1 MY2025 Behavioral Health/HARP Quality Measure Set, arranged alphabetically, and includes measure title, measure steward, and Department-recommended measure classification. The measure set is redlined to highlight changes made between MY2024 and MY2025; please refer to the key at the end of this table for an explanation of redlined formatting.

Behavioral Health/HARP Measures Measure Steward Classification
Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA) CMS P4P
Adult Immunization Status - Electronic (Influenza)(AIS- E)^ NCQA P4P
Asthma Medication Ratio (AMR) NCQA P4P
Breast Cancer Screening (BCS-E)^ NCQA P4P
Cervical Cancer Screening (CCS; CCS-E)* NCQA P4P
Chlamydia Screening in Women (CHL)^ NCQA P4P
Colorectal Cancer Screening (COL-E) NCQA P4P
Continuing Engagement in Treatment Alcohol and Other Drug Dependence (CET) NYS P4R
Controlling High Blood Pressure (CBP) NCQA P4P
COVID-19 Immunization Measure (CVS)^ NYS P4P
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) NCQA P4P
Eye Exam for Patients With Diabetes (EED)^ NCQA P4P
Follow-Up After Emergency Department Visit for Mental Illness (FUM) NCQA P4P
Follow-Up After Emergency Department Visit for Substance Use (FUA) NCQA P4P
Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) NCQA P4P
Follow-Up After Hospitalization for Mental Illness (FUH) NCQA P4P
Glycemic Status Assessment for Patients with Diabetes (GSD) NCQA P4P
Initiation of Pharmacotherapy upon New Episode of Opioid Dependence (POD-N) NYS P4P
Kidney Health Evaluation for Patients with Diabetes (KED) NCQA P4P
Pharmacotherapy for Opioid Use Disorder (POD) NCQA P4P
Potentially Preventable Mental Health-Related Readmission Rate 30 Days (PPR-MH) NYS P4P
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan CMS P4R
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention NCQA P4R
Social Need Screening and Intervention (SNS-E) NCQA P4P
Statin Therapy for Patients with Cardiovascular Disease (SPC) NCQA P4P
Use of Pharmacotherapy for Alcohol Abuse or Dependence (POA) NYS P4R

^Measure Revised for MY2025
Retired/Removed for MY2025
*Revised for MY2025 - ECDS (HEDIS Electronic Clinical Data Systems) Reporting ONLY

Category 2

The table below displays the Category 2 MY2025 Behavioral Health/HARP Quality Measure Set and includes the measure title and measure steward. All Category 2 measures are classified as P4R in MY2025. Category 2 measures were reviewed in detail this year and streamlined to include only those with an active measure steward and/or potential for movement to Category 1 in subsequent years. The measure set is redlined to highlight changes made between MY2024 and MY2025; please refer to the key at the end of this table for an explanation of redlined formatting.

BEHAVIORAL HEALTH/HARP Measures Measure Steward
Asthma Action Plan AAAAI
Asthma: Assessment of Asthma Control - Ambulatory Care Setting AAAAI
Mental Health Engagement in Care 30 Days NYS
Percentage of HARP Enrolled Members Who Received Personalized Recovery Oriented Services (PROS) or Home and Community-Based Services (HCBS) NYS
Use of Opioid Dependence Pharmacotherapy NYS

Retired/Removed for MY2025

Appendix A

The table below identifies the changes to the Category 1 and Category 2 measures for the MY2025 HARP Quality Measure Set.

Category 1 Measure Changes from 2024 to 2025

Measure Name Change Rationale for Change
Adult Immunization Status - Electronic (Influenza)(AIS-E) Specification Change Added a hepatitis B immunization indicator
Cervical Cancer Screening (CCS) Reporting Specification Change ECDS* reporting only
Chlamydia Screening in Women (CHL) Name Change Gender inclusive measurement
COVID-19 Immunization Measure (CVS) Specification Change Enrollment/anchor dates, measurement period, and CDC vaccine codes updated.
Eye Exam for Patients with Diabetes (EED) Specification Change Removed hybrid data collection method

Category 2 Measure Changes from 2024 to 2025

Measure Name Change Rationale for Change
Mental Health Engagement in Care 30 Days Removed from measure set Measure no longer supported by steward

*ECDS: HEDIS Electronic Clinical Data Systems

__________________________________________________________

1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). 1
2. New York State Department of Health, Medicaid Redesign Team, Value Based Payment: Update, May 2023. (Link) 2
3. HEDIS® Measurement Year 2025 Volume 2 Technical Specification for Heath Plans, General Guidelines section 31. 3
4. DOH 4255 has been updated, Section C 2e, to include a Quality Measure Race and Ethnicity Stratification section (Link) 4

5. New York State Department of Health, Medicaid Redesign Team, Value Based Payment: Update, May 2023. (Link) 5

|top of page|